Physicians are being encouraged to curtail prescribing of powerful narcotics in response to the nation’s opioid crisis. So some patients who need relief from pain due to chronic conditions, trauma, or post-surgical recovery are turning to over-the-counter options. But just because they’re sold at your local drug store doesn’t mean OTC drugs are completely safe either.
Retail pain medications also pose risks, especially for older adults who may not be aware of potential drug interactions, differences in how a person’s body breaks absorbs drugs and serious side-effects such as gastrointestinal bleeding. Cheryl Clark, whose recent MedPage Today series examined California’s crackdown on narcotic overprescribers, created a new AHCJ tip sheet to help journalists better report on the risks and benefits of various OTC analgesics, including NSAIDs and acetaminophen.
Clark notes that many patients don’t bother to read the fine print on packing and inserts — assuming they can even see it. So they may not be aware that NSAID overuse can cause serious harm, such as kidney damage, heart attack and stroke. Even good old Tylenol can lead to liver damage if taken too much and too often.
Chronic pain among older adults is a legitimate and serious problem. According to this article in NIH Medline Plus, “50 percent of older adults who live on their own and 75-85 percent of the elderly in care facilities suffer from chronic pain.” Underrated chronic pain can lead to other health issues, such as depression, social isolation, loss of mobility and poor sleep. Making matters more complicated, three-quarters of older adults have two or more chronic conditions, such as heart disease and diabetes. So, pain may occur for multiple reasons, and in multiple locations.
This leaves many physicians with a quandary: prescribe stronger, possibly addictive, medication more effective for conditions like severe arthritis, back, or post-surgical pain, or hope that patients don’t routinely pop a handful of “extra strength” NSAIDs every four hours, ‘round the clock.
Non-pharmacologic approaches to pain management are seemingly given short shrift in medical journals, according to Clark. Meanwhile, physicians struggle to balance the treatment of patients with legitimate pain management needs with “safer” alternatives that may be less effective and also carry risks. Clark’s tip sheet provides reporters with a wealth of information and story ideas for anyone who wants to explore this topic further.